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City of Eugene <br /> Public Works <br /> Application for Public Improvement Permit Engineering <br /> 858 Pearl Street <br /> Job Number: Eugene, OR 97401 <br /> (541) 682-5291 <br /> FAX: (541) 682-5032 <br /> Contract No: <br /> I, ~G2tP.5t~.~1~ M~-sµn t?1kt.. 'Ti2JJS~(` hereby make application for a PUBLIC IMPROVEMENT PERMIT to <br /> (owner) <br /> construct public improvements in the public way, as described below: <br /> Type of Improvement: - 1~'~t~ ~ ~`F-`C'~t~l`xOt.L ~ fit.- ~~-j <br /> (paving, wastewater, stormwater, street lights) <br /> Location: <br /> (street or easement work is within or subdivision name) <br /> 'ii~~ `Ju~~ c~ [t-L"tYzY?.s~jCC..TIOt~G ~13~ ~jocs`~l Z+'~ lF.t~.T~.tiZ-~LLZ'fob.-1 <br /> North (or east) limit: ~ Pam D • South (or west) limit: ~ G~•~1.. i3~uD . <br /> in strict conformance with City of Eugene standard spec'rfications for public improvements (including current addenda), <br /> construction plans approved by the city engineer or his representative, the current edition of °Procedures for Privately Engineered <br /> Projects "the Eugene City Code, and the standard and special conditions printed on this permit form. The owner/applicant is <br /> responsible for providing a copy of this permit to the contractor performing the work. <br /> Contact Person (par><j ~E ~IPf7°1")v~l~k <br /> T~,s-!~~ 26o Cbu,rr C1~h t2d ~21c~ <br /> Signatur Mailing Address _ <br /> Print signat re ere ~ ~ a~ _ ~E ~ <br /> Date 1 ~ ©9 Phone 5y ~ 3 ~ X43 )a City /State /Zip ~ ~ j <br /> DO NOT WRITE BELOW THIS LINE <br /> PUBLIC IMPROVEMENT PERMIT <br /> Permission is hereby granted to applicant and applicant's. contractor to perform the work stated above, in conformance with <br /> conditions listed above, below, and on the reverse side of this permit form. <br /> The permit shall be void unless the work described herein is completed by: <br /> SPECIAL CONDITIONS <br /> APPROVE Date: S <br /> City EngA er <br /> <br /> Eng: 604 FEBRUARY 20A2 <br /> . White: OwnedDesigner Canary: Contrector Pink Inspector <br /> <br />